When a patient is in a hospital, either as an inpatient or an outpatient, a variety of information concerning the patient may be collected and recorded. This may be in the form of observations, measurements, Dab results, vital sign indicators, procedure reports and associated graphics. Over a long period of treatment, hundreds of pages of information may accumulate in the patient's record.
While the patient is in the hospital, it is typical that many different care givers, administrators, or insurance company employees will desire to view a part of the patient's cumulative record. The conventional paper chart is not always useful, as there is only one copy of it, and some laboratory tests may not be entered into the chart on a timely basis. To solve this problem, hospitals have used a variety of database systems such as hospital information systems (HIS) and clinical information systems (CIS) to store and present patient information on computer displays. However, there is still a substantial amount of data that does not get placed into these systems. A variety of factors may inhibit an automated process of comprehensive retrieval of a patient's data, such as incompatible communication protocols and formatting schemes between computer systems, non-digitized data records including pictures and standardized forms, and the lack of adequate computer interfacing support for low-cost medical instruments or devices. It is also typical that word processing documents, rather than being automatically collected by a database system, are simply printed in the form of a paper copy to be inserted into the conventional chart.
While various standardization committees have been established, e.g., HL-7, DOCOM, and IEEE, to develop common addressing schemes for hospital data, to date none have defined a consistent format to use for storing and retrieving data. For the sake of simplicity or due to limited resources, many manufacturers that use one or more of these standards choose to use only a portion of them; consequently their systems remain only partially compatible.
Furthermore, even many hospitals with database systems lack a centralized retrieval system because related hospital reports are often stored on separate databases. For example, a patient's radiology catheterization report and hemodynamic catheterization reports may be created and stored in separate databases, though as far as the physician who performed the catheterization procedure is concerned, these two reports are really just one procedure and should be associated with each other. For further example, a physician reviewing an admission report may find that it references laboratory tests or observations made contemporaneous with or previous to the patient arriving at the hospital. Should the physician decide to review these other records, she will have to perform additional searches to locate them. In some cases, this often cumbersome and time-consuming process results in care givers refraining from making complete use of the available patient information.
In many hospitals when a patient is discharged, a paper copy of these records is made and sent to the admitting physician for his own record keeping purposes. The collection, copying, and storage of all of these records is a very time-consuming and labor-intensive activity. Further, the generally high risk of human error may manifest itself in the failure to return records to the correct patient's file or incorrect storage of a patient's entire file, effectively forfeiting the misplaced information. The physician is simultaneously confronted with the responsibility of filing and storing the paper copy in his own office.
Some hospitals have purchased laboratory or information systems capable of long term storage of various records. While this may assist the hospital in retrieving past records, it may not help the admitting physician in referring to them, for he may not have access to the data directly or may not have the specific software required to retrieve the data. So with such advanced systems the physician is still provided with a paper copy for his records.
Furthermore, many existing laboratory and information systems record information in a variety of inconsistent formats. Some of these formats are proprietary to the manufacturer of the specific system. Each system may use a separate database scheme to gain access to the data. Substantial efforts to get these systems to communicate with each other have not yielded satisfactory results. For example, many large medical information systems use complicated data exchange protocols; but these protocols are unwieldy for simple, often portable instruments which lack the hardware and software capacity to conform to such protocols.
Some reports may be created using a word processor. These may originate in a department of the hospital or in a physician's office. These reports, which may be kept in a conventional file cabinet, are not always included with the rest of the patient's reports.
What is needed is an effective alternative to creating paper records that must be copied and meticulously tracked, an alternative that would permit physicians to access the data economically and easily in their own offices. Such a system would permit a system user to enter a keyword to retrieve a specific data record of a patient, retrieve the requested record from whichever database it is stored to, reformat the data record with hypertext links to related patient records, and return the requested record to the system user for display on a browser. The system would preferably use the well-known Hypertext Markup Language (HTML) so that it could utilize inexpensive, standard software packages. The system would also be operable to format data records stored on the various databases of the computer network systematically, periodically, or automatically upon the creation of new, or the modification of existing, data records. The system would be operable to collect all data records pertaining to a specific patient, doctor, or other subject, modify them to support display through a Java applet, internet browser, or other universal display standard, generate additional patient files to organize the data records in a hypertext directory structure, and store the data records and files on a mass-media storage device such as a CD-ROM.